Question

contrast the definition of explicit and implicit criteria of quality of health care

Answer 1

Explicit criteria: Explicit criteria indicates decisions made by an administrative authority as to the amount and types of resources to be made available, specific rules and eligible population for allocation. Significant amount of explicit criteria occur in private and public plans regarding levels of available facility, technology, location, programs, and expenditure levels. In this criteria society enacts transparent and precise rules that determine the circumstances under which certain persons can claim medical services. Explicit health care standards appear in a variety of forms such as protocols, procedures or clinical practice guidelines. The standards may be developed by hospital itself, professional organizations (e.g: nursing councils, medical associations), government entities (CMS), accrediting organizations (e.g: Joint Commission International) or international organizations (e.g: the World Health Organization) .

Implicit criteria : Implicit criteria derive from the expertise of professionals who work in a specific environment. It implies decisions made by managers, professionals, and other health personnel functioning within a specific budget allowance. For example, professionals working in a pediatric ward may know the treatment that a baby who is dehydrated may need, but may have different opinion about the way to provide the treatment (e.g., dosage, duration, and frequency). Here society determines the share of GDP that is financed by taxes or mandatory contributions and devoted to the healthcare sector, but leaves it to physicians to allocate services to individual patients. Besides a global budget for the healthcare system as a whole, individual budgets for healthcare providers like hospitals are a typical instrument in this type of rationing.

To achieve expected health outcomes, standards must be :

• Measurable - Performance according to the standards must be assessed and quantified
• valid - Standards must be based on scientific evidence or other acceptable experience

• Clear - The standards are understood in the same way by everyone and should not be subjected to misinterpretation or distortion

• Realistic - the standards should be followed or achieved with existing resources

• Reliable - Following the standards for a specific intervention results in the same outcome